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Systematic Review of the Effects of Skin-to-Skin Care on Short-Term Physiologic Stress Outcomes in Preterm Infants in the Neonatal Intensive Care Unit

Pados, Britt Frisk, PhD, RN, NNP-BC; Hess, Francis

Section Editor(s): Gephart, Sheila

doi: 10.1097/ANC.0000000000000596
Evidence-Based Practice Briefs: PDF Only

Background: Infants in the neonatal intensive care unit (NICU) are exposed to many stressors. There is growing evidence that chronic stress early in life has long-term neurodevelopmental implications. Skin-to-skin care (SSC) is an intervention used to reduce stress in the NICU.

Clinical Question: In premature infants in the NICU, what is the available evidence that SSC improves short-term physiologic stress outcomes compared with incubator care?

Search Strategy: PubMed and CINAHL were searched for terms related to SSC, stress, physiology, and premature infants. Of 1280 unique articles, 19 were identified that reported on research studies comparing SSC with incubator care in the NICU and reported stress-related physiologic outcome measures.

Results: Although there have been some mixed findings, the research supports that SSC improves short-term cardiorespiratory stress outcomes compared with incubator care. The evidence is clearer for studies reporting stress hormone outcomes, with strong evidence that SSC reduces cortisol and increases oxytocin levels in preterm infants.

Implications for Practice and Research: SSC is safe and has stress-reducing benefits. SSC should be considered an essential component to providing optimal care in the NICU. More research is needed to determine the timing of initiation, duration, and frequency of SSC to optimize the stress-reducing benefits. Future research should include the most fragile infants, who are most likely to benefit from SSC, utilize power analyses to ensure adequate sample sizes, and use sophisticated data collection and analysis techniques to more accurately evaluate the effect of SSC on infants in the NICU.

Boston College William F. Connell School of Nursing (Dr Pados) and Boston College Carolyn A. and Peter S. Lynch School of Education (Mr Hess), Chestnut Hill, Massachusetts.

Correspondence: Britt Frisk Pados, PhD, RN, NNP-BC, Boston College William F. Connell School of Nursing, Maloney Hall 268, 140 Commonwealth Ave, Chestnut Hill, MA 02467 (

Institution Where Work Occurred: Boston College.

The authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses